Not understanding why you are depressed can lead to unhelpful, depression-reinforcing assumptions and self-bullying attempts to ‘snap out of it’. Learning more about how depression works in a self-reinforcing spiral and what kinds of factors can make you vulnerable can help you take a more self-compassionate attitude towards your depression. This module helps you understand your own depression better as a foundation for taking a more self-caring approach, which is vital as the foundation for all other strategies for overcoming depression.

Contents

1. How Depression is Affecting Me 2

2. How My Depression Works

6

3. Why Me, Why Now? 7

4. Framework For Understanding My Depression

16

Module 5Understand Your

Depression

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Page 1 of 20

An important rule of thumb in any campaign is to ‘know your enemy’. Read the What is depression? and How depression works sections to learn more about depression and how it may be affecting you. If you haven’t already done the ‘Am I depressed?’ worksheet in Module 2, then it is repeated here as ‘How depression is affecting me’ for you to use to survey the specific impact your mood is having on your daily life currently. This is an important first step in understanding your own depression. It also gives a good baseline for targeting the most relevant strategies for you. Use this worksheet to check whether and how depression may be affecting you.

1.1. Screening Questions

During the last month, have you often been bothered by feeling down, depressed or hopeless? YES/NODuring the last month, have you often been bothered by having little interest or pleasure in doing things? YES/NO

If you answer YES to both questions then fill in the warning signs checklist.

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1.How Depression Is Affecting Me

1.2. Check the Warning Signs

Warning Signs Yes/No?

If yes, how many days in last two weeks? Which ones?

Persistently sad, anxious, empty or generally low mood Loss of interest/pleasure in doing things Lethargy/decreased energy Problems with sleep (including too much) Appetite/weight changes Increased tearfulness Poor concentration/difficulty with decisions Hopelessness/pessimism Feeling bad about yourself, guilty, or helpless Restlessness or being fidgety, or else markedly slowed down Thoughts of death or suicidePersistently sad, anxious, empty or generally low mood

Remember that many of these signs are an occasional part of normal life. But depression may be a factor if you have been

persistently sad, anxious, empty or low AND you have experienced at least 3 or more of the above signs on more than

half the days in the last two weeks Take it seriously and take action – preferably get professional help. Turn overleaf for a more detailed personal survey to help you assess the specific ways in which depression is affecting you personally.

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1.3. My Daily Life and Functioning Assessment

This detailed personal survey provides a useful inventory of the ways in which depression is affecting your daily functioning.This is a useful record to show a doctor or other professional. It will also help you choose the most effective strategies for tackling your depression and moving forward.

Life Area Section A: Say if present and give detailsFeeling lowSelf-hurting

Suicidal thoughtsFeeling bad about yourself

Feeling hopelessWorries about illnessFeeling unattractive

Other worriesFeeling angry

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Life Area Section B: Say if present and give detailsEating

SleepingGetting out of the house/your room

ExerciseDrinkingSmoking

Other substance useAbility to study

Concentration on courseConcentration on other

thingsGetting work done on time

Being busy in generalTime with friends

Going outSexual activity

Hobbies/societies/other interests

Ability to do paid work (if relevant)

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The How Depression Works section explains how depression can develop and become entrenched in a complex self-reinforcing downward spiral of interacting factors. This worksheet helps you identify the different elements contributing to and maintaining your depression. Understanding this better will help you identify the best strategies for tackling your depression.

2.How My Depression Works

Body/Physiology What ways does my body respond to these circumstances, thoughts & feelings? List things like fatigue or lethargy; chronic illness; indications of stress in your body - racing heart, restlessness, shallow breathing, irritability and hyper-aggression ____________________________________________________________________________________________________________________________________________________________________________________________________________

Behaviour/Actions How does the depression show in how I behave and what I do? List examples of avoidance (like procrastination, skipping lectures or other commitments, social withdrawal), as well as changes in sleep habits, eating, hygiene ... __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Thinking/Attitude Can I identify any examples of unhelpful ‘depressed thinking’ habits? For example: negative tunnel vision, all-or-nothing thinking, emotional reasoning, perfectionism, self-bullying, jumping to conclusions ... _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Mood/Feelings What is my dominant mood and what are the main feelings that I am experiencing? List your mood and feelings with the most prominent first (sad/tearful, empty/ numb, hopeless, uninterested, low, guilty, worthless, helpless, anxious, angry) _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Context What circumstances in my life may contribute to me feeling low? List things causing you stress currently as well as any possible events/experiences in your life which you think may contribute to your current mood. ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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There isn’t usually one simple straightforward cause for depression. Quite often it feels as if there is no good reason for it – but this does not mean that it has struck randomly.

This worksheet will help you consider some of the complex, interacting factors, unique to you, which may have played a role in making you vulnerable to depression. You will also be able to consider any relevant triggers for a specific episode of depression.Considering and understanding these factors in greater depth may be easier with the help of a trained professional, such as a counsellor (See also ‘Counsellors & doctors’)

3.1. Depression Vulnerability

1. My Depression Biology Brain chemicals called neurotransmitters are responsible for regulating our moods. Which (if any) of the following factors affecting neurotransmitters might be relevant in my life?

□ Genetics Am I aware of any depression or other mental health problems in my immediate or wider blood relatives? (Note that this is only a rough indicator – there is no way currently to test for a genetic vulnerability to depression.)

3.Why Me, Why Now?

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□ Early experiences Did I experience significant trauma, neglect, abandonment, abuse as a baby or very young child? (Note that early experiences also have psychological effects – see next section.)

□ Hormones Am I aware of any hormonal issues or conditions that may contribute to mood problems? (eg. pregnancy, breastfeeding, polycystic ovary syndrome, chronic fatigue syndrome, glandular fever, diabetes, thyroid problems)

□ Blood sugar Do I eat a balanced diet, with regular meals and snacks? Am I aware of any connection between what I eat and my mood?

□ Stress What stress factors are there in my life? Are my current coping strategies helping me to manage the stress in my life or not? Do I have any symptoms of ‘chronic stress’?

Write down specific examples of the above factors here:____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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2. My Depression Psychology Do I feel ‘not good enough’ in some way? Do I know what may have led to me feeling this way about myself? Which, if any, of the following types of experience are relevant to my experience?

□ Bad treatment by carers

Have I been badly treated in childhood by parents or carers – have I experienced abuse, neglect, chronic lack of affection and/or criticism?

□ Insufficient care

Has there been a failure in provision of the basic attention, security and care I needed to receive as a child - as a result of parental illness or other incapacity, parents’ own emotional problems, parental divorce or relationship difficulty, for example?

□ Conditional love or approval/acceptance

Have I experienced disapproval or rejection? Does it feel as if my self-worth is dependent on my ‘performance’, in some way? Does it feel as if ‘failure’ would be catastrophic to me?

□ Bullying

Have I experienced bullying or bad treatment at any stage by others besides parents/carers? Did I receive adequate support or help to address or stop it?

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□ ‘Difference’ or lack of acceptance

Have I felt, or been made to feel, painfully ‘different’ from others? Have I experienced negative effects for this difference? (see also Depression sociology)

□ Other

Are there other experiences which have contributed to low self-worth or feeling ‘not good enough’?

It may feel helpful to write down specific examples of any of the above experiences. The reason experiences like this are important to identify is that they often become internalised as ‘evidence’ about our self-worth, leading to unfair self-blame or low self-esteem. Understanding why we have come to think this way about ourselves is an important first step towards changing our attitude towards ourselves – the next step is to learn how to offer ourselves compassion and care instead of criticism and self-blame. ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3. My Depression Sociology

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Social circumstances play a significant role in vulnerability to depression. Which of the following social factors might be contributing to my depression?

□ Isolation Am I suffering from loneliness or lack of sufficient meaningful connection? Have my friendships been disrupted in some way (for example, due to leaving home and starting at uni)?

□ Prejudice or discrimination Have I experienced prejudice or discrimination due to unhelpful social or cultural attitudes (for example, racism or homophobia)?

□ Poverty or financial stress Am I experiencing financial stress? Do I have appropriate support/coping strategies in place to help me deal with this financial stress?

□ Chronic stress/helplessness Do I have adequate support and/or coping strategies to deal with the stress in my life currently? Or do I feel out of control?

□ Social comparison Are my own goals and attitudes to myself affected by unrealistic social norms around ‘success’, ‘attractiveness’, and so on? Do I impose perfectionist standards on myself to try to meet these goals?

□ Lack of support Is something stopping me from accessing appropriate support – either inadequacy of support provision and/or resistance in myself to seeking

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support (perhaps through unhelpful social attitudes about ‘dependence’ vs ‘independence’)?

□ Cynicism/lack of meaning Have I lost sight of what is really important to me – what gives life meaning and offers real happiness? How much choice I have I exercised in considering the values and goals I sign up to?

It may feel helpful to write down specific examples of any of the above factors. It is important to recognise that many of the factors making you vulnerable to depression are not specific to you – that depression is a growing problem in our world and therefore cannot be seen as ‘your fault’.______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4. Depression Triggers Are there any recent circumstances which may have played a role in setting off a downward spiral into depression, for me?

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□ Traumatic event or loss Have I experienced a traumatic event, or a loss such as a bereavement of relationship break up, which has temporarily overwhelmed my coping resources?

□ Major change in circumstances Have I been having difficulty adapting to new circumstances in my life? Are my coping resources feeling inadequate to address the stresses and challenges of my new situation?

□ Experience of failure or fear of failure Am I facing failure, or fearing failure, in a way which is important to me?

□ Illness or other withdrawal from normal activity Has something caused me to experience an enforced period of withdrawal from meaningful tasks and/or a sense of purpose and engagement (such as illness, unemployment/retirement, long vacation period)?

□ Isolation or social withdrawal Have I become cut off from social support and interaction? For example, has it been difficult to make new friends in a new situation?

□ Disruption to basic daily routines Is my lifestyle conducive to my emotional wellbeing? Have I been experiencing disrupted or unhealthy patterns of sleep, eating, exercise, substance use, work etc?

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□ Other What other possible triggers can I identify which may have contributed or be contributing to my depression?

It may be useful to write down specific examples for each of the relevant factors, as well as identifying the ways in which your daily functioning is being affected by depression. This helps target the areas which it would be most useful to address when choosing strategies to tackle your depression:__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3.2. What Have I Learnt?

What is the most important thing you have learnt from this worksheet? What has surprised you in considering the factors which may be contributing to your

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depression? Are your ready to evaluate your choice of strategies for tackling your depression and moving forward? __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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4.Framework For Understanding My

Depression

Understanding how and why depression is affecting you is the best way to plan the most effective strategies for tackling it.

Use this worksheet to summarise what you know about your own depression so that you can:

evaluate the relevance of the strategies you may already have tried plan further targeted strategies

4.1. Daily Functioning

How is depression affecting you? Can you identify the most significant moods, thought patterns, daily habits and impacts on your functioning and general relationships and interactions with others? Summarise your learning from the ‘Am I depressed?’ and the ‘How my depression works’ sections: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4.2. Triggers

What triggers have you been able to identify which may have set off a downward spiral in your life? Examples:

a traumatic event or loss, such as a bereavement or relationship break up

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major change in circumstances experiences of failure or fear of failure illness or other period of inactivity

Summarise what you have learnt about your triggers from the Why Me, Why Now? section:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4.3. Vulnerability Factors

What are the possible biological, psychological and social factors which may have made you personally vulnerable to depression? Summarise what you have learnt about your vulnerability factors from the Why Me, Why Now? section.

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______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4.4. Useful Immediate Strategies

What strategies have you already tried and how helpful have they been? What other strategies might help you take immediate steps to tackle your depression?Use the Self-help first steps and then the Healthier daily routines sections to identify the most immediately effective strategies for turning the depression spiral around, and choose which are most relevant in addressing the way in which depression is affecting you:______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4.5. Longer-Term Strategies

What longer-term strategies have you tried in the past and how helpful have they been? What other longer-term strategies do you think you might consider? Use the Changing attitudes and Living well sections to identify strategies and skills for longer-term protection against depression and how to live a happier life. Choose which strategies are most relevant in addressing the triggers and vulnerabilities you have identified as pertinent to your depression:____________________________________________________________________________________________________________________________________________________________________

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____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Evaluate: Of the strategies identified in the last two sections of this worksheet, which would be the most effective thing for me to do next?____________________________________________________________________________________________________________________________________________________________________

Commit: In order to make a start with this next strategy, my first step is: ____________________________________________________________________________________________________________________________________________________________________

I will do this on: (date) ____________________________________________________________________________

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Next StepsUse this framework to review your list of depression-beating strategies using the ‘Finding what works for you’ section.

Goal to Work TowardsWhen you have successfully tackled your depression using some of these strategies then you may be able to use this framework to write down your own story. See the Take Action section for how to share your story on Students Against Depression.org and help others.